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Shnayder-Adams MM, Masotti M, Sanogo ML. Clinical Outcomes after Median Arcuate Ligament Release in Patients Responsive to Celiac Plexus Block. J Vasc Interv Radiol 2024; 35:558-562. [PMID: 38181971 DOI: 10.1016/j.jvir.2023.12.569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 12/04/2023] [Accepted: 12/27/2023] [Indexed: 01/07/2024] Open
Abstract
PURPOSE To determine if symptom relief with celiac plexus block (CPB) is associated with favorable clinical outcomes after median arcuate ligament release (MALR) surgery. MATERIALS AND METHODS A retrospective review was performed from January 2000 to December 2021. Fifty-seven patients (42 women, 15 men; mean age, 43 years [range, 18-84 years]) with clinical and radiographic features suggestive of median arcuate ligament syndrome (MALS) underwent computed tomography (CT)-guided percutaneous CPB for suspected MALS. Clinical outcomes of CPB and MALR surgery were correlated. Adverse events were classified according to the Society of Interventional Radiology (SIR) guidelines. RESULTS CT-guided percutaneous CPB was successfully performed in all 57 (100%) patients with suspected MALS. A cohort of 38 (67%) patients showed clinical improvement with CPB. A subset of 28 (74%) patients in this group subsequently underwent open MALR surgery; 27 (96%) responders to CPB showed favorable clinical outcomes with surgery. There was 1 (4%) CPB-related mild adverse event. There were no moderate, severe, or life-threatening adverse events. CONCLUSIONS Patients who responded to CPB were selected to undergo surgery, and 96% of them improved after surgery.
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Affiliation(s)
- Michelle M Shnayder-Adams
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health Systems, Ann Arbor, Michigan
| | - Maria Masotti
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Mamadou L Sanogo
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health Systems, Ann Arbor, Michigan.
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2
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Brenner DM, Brandt LJ, Fenster M, Hamilton MJ, Kamboj AK, Oxentenko AS, Wang B, Chey WD. Rare, Overlooked, or Underappreciated Causes of Recurrent Abdominal Pain: A Primer for Gastroenterologists. Clin Gastroenterol Hepatol 2023; 21:264-279. [PMID: 36180010 DOI: 10.1016/j.cgh.2022.09.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/07/2022] [Accepted: 09/08/2022] [Indexed: 01/28/2023]
Abstract
Recurrent abdominal pain is a common reason for repeated visits to outpatient clinics and emergency departments, reflecting a substantial unmet need for timely and accurate diagnosis. A lack of awareness of some of the rarer causes of recurrent abdominal pain may impede diagnosis and delay effective management. This article identifies some of the key rare but diagnosable causes that are frequently missed by gastroenterologists and provides expert recommendations to support recognition, diagnosis, and management with the ultimate aim of improving patient outcomes.
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Affiliation(s)
- Darren M Brenner
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Lawrence J Brandt
- Division of Gastroenterology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Marc Fenster
- Division of Gastroenterology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Matthew J Hamilton
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts
| | - Amrit K Kamboj
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Amy S Oxentenko
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona
| | - Bruce Wang
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - William D Chey
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan
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3
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Yamamoto H, Matsuoka R, Tsuyuki Y, Kamimura K, Tsukamoto K, Tachibana M, Aoyama T, Kanamori N, Tsutsumi Y. Acalculous Ischemic Cholecystitis Caused by Spontaneous Celiac Artery Dissection. Intern Med 2022; 61:53-58. [PMID: 34176844 PMCID: PMC8810253 DOI: 10.2169/internalmedicine.7793-21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 05/11/2021] [Indexed: 11/06/2022] Open
Abstract
We herein report a case of spontaneous isolated dissection of the celiac artery. A Japanese man in his 50s visited an emergency unit, complaining of sudden epigastralgia. Contrast-enhanced computed tomography indicated dissection of the celiac artery with patent false and true lumina, extending to the splenic and common hepatic arteries. On day 3 of hospitalization, the dissection progressed to the proper and right hepatic arteries. Progression of the dissection to the right hepatic artery provoked acalculous ischemic cholecystitis, and cholecystectomy followed. The resected gallbladder revealed extensive aseptic necrosis with little inflammatory reaction, and the gallbladder neck was spared from ischemia.
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Affiliation(s)
| | - Ryota Matsuoka
- Department of Cardiology, Shimada Municipal Hospital, Japan
| | | | | | - Kei Tsukamoto
- Department of Diagnostic Radiology, Shimada Municipal Hospital, Japan
| | | | - Takeshi Aoyama
- Department of Cardiology, Shimada Municipal Hospital, Japan
| | - Norio Kanamori
- Department of Cardiology, Shimada Municipal Hospital, Japan
| | - Yutaka Tsutsumi
- Department of Diagnostic Pathology, Shimada Municipal Hospital, Japan
- Diagnostic Pathology Clinic, Pathos Tsutsumi, Japan
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4
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Iqbal S, Chaudhary M. Median arcuate ligament syndrome (Dunbar syndrome). Cardiovasc Diagn Ther 2021; 11:1172-1176. [PMID: 34815969 DOI: 10.21037/cdt-20-846] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 03/25/2021] [Indexed: 01/08/2023]
Abstract
Median arcuate ligament syndrome (MALS) is a rare condition which is due to the compression of celiac trunk by low riding of fibrous attachments of median arcuate ligament and diaphragmatic crura. Technically, MALS is a diagnosis of exclusion, consisting of vague symptoms comprising of postprandial epigastric pain, nausea, vomiting and unexplained weight loss. Different imaging modalities like Doppler ultrasound, computed tomography, magnetic resonance imaging and mesenteric angiogram are helpful to demonstrate celiac axis compression. The goal of treatment is decompression of celiac trunk either by open, laparoscopic or robotic method along with adjuvant interventional procedures like percutaneous transluminal angioplasty (PTA) and stenting. Surgical is the mainstay of treatment. This approach is based on open, laparoscopic or robotic release of compressed ligament along with celiac ganglionectomy and celiac artery revascularization. The role of interventional radiology is limited to angioplasty and stenting to open the stenosis rather than addressing the underlying compression of celiac trunk which has resulted in the symptoms. However, both the diagnosis and therapeutic intervention remains challenging. Extensive evaluation of etiology and pathophysiology of MALS and addressing the same through minimally invasive techniques may yield best prognosis in future. In this review article, we discuss briefly about the MALS in terms of etiology, diagnosis and its management including the role of interventional radiology.
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Affiliation(s)
- Shams Iqbal
- Department of Interventional Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Mahesh Chaudhary
- Department of Interventional Radiology, Massachusetts General Hospital, Boston, MA, USA
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5
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Chronic Non-specific Upper Abdominal Pain of Median Arcuate Ligament Syndrome: Laparoscopic Treatment. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02355-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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6
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Li J, Tan XY, Megahed A, Evangelista A. Dunbar syndrome: An unusual cause of chronic postprandial abdominal pain. Radiol Case Rep 2020; 15:1747-1749. [PMID: 32774573 PMCID: PMC7397697 DOI: 10.1016/j.radcr.2020.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/28/2020] [Accepted: 07/04/2020] [Indexed: 12/04/2022] Open
Abstract
Median arcuate ligament syndrome (MALS), also known as Dunbar syndrome, is a rare condition in which the celiac artery is compressed by the median arcuate ligament of the diaphragm. We hereby report a case of a 48-year-old female presenting with long-standing abdominal pain and ninety-pound weight loss who was found to have median arcuate ligament syndrome after extensive workup.
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7
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Petnys A, Puech-Leão P, Zerati AE, Ritti-Dias RM, Nahas WC, Neto ED, De Luccia N. Prevalence of signs of celiac axis compression by the median arcuate ligament on computed tomography angiography in asymptomatic patients. J Vasc Surg 2018; 68:1782-1787. [DOI: 10.1016/j.jvs.2018.04.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 04/03/2018] [Indexed: 10/28/2022]
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8
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Razumovsky AY, Mitupov ZB, Feoktistova EV, Gurevich AI, Titova EA, Yusufov AA, Svetlov VV, Nagornaya YV. [Laparoscopic decompression of celiac trunk in children]. Khirurgiia (Mosk) 2017:44-51. [PMID: 29076481 DOI: 10.17116/hirurgia20171044-51] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
MATERIAL AND METHODS For the period 2013-2016 four patients were treated at the Filatov Children's City Clinical Hospital #13. There were 2 children aged 14 years and 2 children aged 17 years. All patients have been diagnosed via anamnesis, complaints, pulse-wave doppler sonography, contrast-enhanced MDCT and angiography. After comprehensive examination 3 patients underwent laparoscopic decompression of celiac trunk. In all cases celiac trunk compression was predominantly caused by median arcuate ligament of the diaphragm combined with neurofibrotic tissue of celiac plexus. RESULTS All patients were discharged after laparoscopic decompression of celiac trunk. Intra- and postoperative complications, as well as cases of conversion were absent. Mean time of surgery was 65 minutes. In all cases postoperative period was smooth (4 days on the average). Two patients underwent follow-up examination in long-term postoperative period: pulse-wave doppler sonography, contrast-enhanced MDCT and angiography. In both cases reduced severity, incidence and duration of pain syndrome were observed. CONCLUSION Clinical examples show some problems in diagnosis and treatment of compressive stenosis of celiac trunk due to rarity of pathology especially in childhood. Nevertheless, combination of abdominal ischemia and celiac trunk stenosis confirmed by instrumental diagnosis is indication for surgical treatment.
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Affiliation(s)
- A Yu Razumovsky
- Chair of Pediatric Surgery of Pirogov Russian Research Medical University of Healthcare Ministry of the Russian Federation, Moscow, Russia
| | - Z B Mitupov
- Chair of Pediatric Surgery of Pirogov Russian Research Medical University of Healthcare Ministry of the Russian Federation, Moscow, Russia
| | - E V Feoktistova
- Dmitry Rogachev National Research and Practical Center for Pediatric Hematology, Oncology and Immunology of Healthcare Ministry of the Russian Federation, Moscow, Russia
| | - A I Gurevich
- Filatov Children's City Clinical Hospital N 13 of Moscow Department of Healthcare, Moscow, Russia
| | - E A Titova
- Filatov Children's City Clinical Hospital N 13 of Moscow Department of Healthcare, Moscow, Russia
| | - A A Yusufov
- Children's Regional Clinical Hospital, Tver, Russia
| | - V V Svetlov
- Children's Regional Clinical Hospital, Tver, Russia
| | - Yu V Nagornaya
- Chair of Pediatric Surgery of Pirogov Russian Research Medical University of Healthcare Ministry of the Russian Federation, Moscow, Russia
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9
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Ho KKF, Walker P, Smithers BM, Foster W, Nathanson L, O'Rourke N, Shaw I, McGahan T. Outcome predictors in median arcuate ligament syndrome. J Vasc Surg 2017; 65:1745-1752. [DOI: 10.1016/j.jvs.2016.11.040] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 11/16/2016] [Indexed: 10/20/2022]
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10
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Tribble CG, Harman PK, Mentzer RM. Celiac Artery Compression Syndrome: Report of a Case and Review of Current Opinion. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/153857448602000211] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The celiac artery compression syndrome (or median arcuate ligament syn drome) is characterized by postprandial abdominal pain, an epigastric bruit, and arteriographic evidence of significant extrinsic compression of the celiac artery. Although the concept of extrinsic compression of vessels is well estab lished in vascular surgery, the existence of the celiac artery compression syn drome has been a matter of controversy. A patient relieved of celiac artery compression and postprandial pain is presented. A review of the controversy and an approach to evaluating patients suspected of having this type of com pression is outlined.
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Affiliation(s)
- Curtis G. Tribble
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - P. Kent Harman
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Robert M. Mentzer
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
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11
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Sultan S, Hynes N, Elsafty N, Tawfick W. Eight years experience in the management of median arcuate ligament syndrome by decompression, celiac ganglion sympathectomy, and selective revascularization. Vasc Endovascular Surg 2013; 47:614-9. [PMID: 23942948 DOI: 10.1177/1538574413500536] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We aim to review an 8-year experience of median arcuate ligament syndrome (MALS) with chronic gastrointestinal ischemia (CGI) and evaluate clinical outcomes of arcuate ligament decompression, celiac sympathectomy, and selective revascularization. Between December 2002 and March 2012, of 25 patients referred with symptoms of CGI, 11 patients (10 women and 1 man) had clinical signs of abdominal angina and radiological evidence of MALS. Mean age was 50 ± 20.4 years. Median symptom duration was 34 months. All patients had median arcuate decompression and celiac sympathectomy. In all, 8 did not require revascularization, 2 had retrograde celiac and/or superior mesenteric artery (SMA) stenting, and 1 had SMA bypass. There was no mortality. The 30-day morbidity was 9%. Mean follow-up was 60 months. Eight patients noted complete relief of abdominal pain, and 1 reported some improvement. The MALS is not solely a vascular compression syndrome. The neurological component requires careful celiac plexus sympathectomy in addition to arcuate ligament decompression.
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Affiliation(s)
- Sherif Sultan
- 1Department of Vascular and Endovascular Surgery, Western Vascular Institute, Galway University Hospital, Galway, Ireland
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12
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Meyer M, Gharagozloo F, Nguyen D, Tempesta B, Strother E, Margolis M. Robotic-assisted treatment of celiac artery compression syndrome: report of a case and review of the literature. Int J Med Robot 2012; 8:379-83. [DOI: 10.1002/rcs.1448] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2012] [Indexed: 01/07/2023]
Affiliation(s)
- Mark Meyer
- Washington Institute of Thoracic and Cardiovascular Surgery; The George Washington University Medical Center; Washington; DC; USA
| | - Farid Gharagozloo
- Washington Institute of Thoracic and Cardiovascular Surgery; The George Washington University Medical Center; Washington; DC; USA
| | - Duy Nguyen
- Washington Institute of Thoracic and Cardiovascular Surgery; The George Washington University Medical Center; Washington; DC; USA
| | - Barbara Tempesta
- Washington Institute of Thoracic and Cardiovascular Surgery; The George Washington University Medical Center; Washington; DC; USA
| | - Eric Strother
- Washington Institute of Thoracic and Cardiovascular Surgery; The George Washington University Medical Center; Washington; DC; USA
| | - Marc Margolis
- Washington Institute of Thoracic and Cardiovascular Surgery; The George Washington University Medical Center; Washington; DC; USA
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13
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Okten RS, Kucukay F, Tola M, Bostanci B, Cumhur T. Is celiac artery compression syndrome genetically inherited?: A case series from a family and review of the literature. Eur J Radiol 2012; 81:1089-93. [DOI: 10.1016/j.ejrad.2011.02.064] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Accepted: 02/28/2011] [Indexed: 10/18/2022]
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14
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Kohn GP, Bitar RS, Farber MA, Marston WA, Overby DW, Farrell TM. Treatment Options and Outcomes for Celiac Artery Compression Syndrome. Surg Innov 2011; 18:338-43. [DOI: 10.1177/1553350610397383] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Abdominal pain attributed to compression of the celiac artery at the level of the median arcuate ligament (MAL) of the diaphragm is an uncommon disorder. Although ultrasound investigation and arteriography can be suggestive of the diagnosis, no definitive criteria exist with only cases reports in the literature. This study presents the only known reported case series in which a combination of open and laparoscopic access techniques of MAL decompression are reported. Methods. A retrospective review of prospectively collected electronic databases of the University of North Carolina at Chapel Hill was performed for the period February 1999 until February 2009. Patients having undergone operation for celiac artery compression syndrome were identified and participated in a telephone interview. Questions were asked about the success of the operation, the recovery period, and patient satisfaction. Results. Six patients were identified, 3 were male; mean age was 37.7 years. Four underwent open MAL division and celiac ganglion neurolysis, and 2 underwent a laparoscopic approach. Mean follow-up was 48.6 months. All patients experienced symptomatic improvement and were satisfied with their outcome. No patient had symptoms recurrence. Conclusion. In this limited experience, MAL division with celiac ganglion neurolysis appears to be an effective treatment for celiac artery compression syndrome in appropriately selected patients. Both the open and laparoscopic approaches are safe with durable midterm follow-up results.
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Affiliation(s)
- Geoffrey P. Kohn
- Monash University, Melbourne, Victoria, Australia
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Raghid S. Bitar
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mark A. Farber
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - D. Wayne Overby
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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15
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Roseborough GS. Laparoscopic management of celiac artery compression syndrome. J Vasc Surg 2009; 50:124-33. [PMID: 19563960 DOI: 10.1016/j.jvs.2008.12.078] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2008] [Revised: 12/04/2008] [Accepted: 12/21/2008] [Indexed: 10/20/2022]
Abstract
BACKGROUND Celiac artery compression syndrome (CACS) remains a controversial diagnosis, despite several reported series documenting therapeutic efficacy of CA decompression. Traditional therapy consists of open surgical decompression, but since 2000, five isolated case reports have been published in which CACS has been successfully treated with laparoscopic techniques. This approach was adopted as the sole initial therapy for CACS at the Johns Hopkins Hospital in 2002. This article reports the results of a unique surgical series that triples the reported worldwide experience with this therapy. METHODS Fifteen patients (median age, 40.6 years) diagnosed with CACS underwent laparoscopic decompression by a single vascular surgeon. CACS was diagnosed by digital subtraction angiography in 14 patients and computed tomography (CT) angiography in one patient, with images acquired in both expiratory and inspiratory phases of respiration. CA decompression was offered after the results of a thorough workup for other pathology were negative, including upper and lower endoscopy, CT scanning, gastric and gallbladder emptying studies, upper gastrointestinal series, and small-bowel follow-through studies. Indications in all patients were abdominal pain and weight loss (average, 9 lbs). The procedure consisted of laparoscopic division of the median arcuate ligament and complete lysis of the CA from its origin on the aorta to its trifurcation. RESULTS Between November 2002 and September 2007, 15 consecutive patients underwent laparoscopic CA decompression. Median length of follow-up was 44.2 months. There were no operative deaths. Four patients were converted intraoperatively to an open decompression, all for intraoperative bleeding; only one required a blood transfusion. Average operating time was 189 minutes, and the average length of stay was 3.5 days. CA intervention was required in six patients, including three intraoperative procedures (1 patch angioplasty, 1 celiac bypass, 1 percutaneous angioplasty) and six late procedures (2 percutaneous angioplasties, 3 percutaneous stents, 1 celiac bypass). One complication occurred, a severe case of pancreatitis that developed 1 week after discharge. On follow-up, 14 of 15 patients subjectively reported significant improvement, and one patient remains symptomatic with no diagnosis. CONCLUSION Laparoscopic decompression of the CA may be a useful therapy for CACS, but there is potential for vascular injury, and adjunctive CA intervention is often required. Surgeons should consider laparoscopic CA decompression as a therapeutic alternative for CACS and should participate in the care of patients with this diagnosis.
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Affiliation(s)
- Glen S Roseborough
- Division of Vascular Surgery, Johns Hopkins University, Johns Hopkins Hospital, Baltimore, MD 21287, USA.
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16
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Seconds from disaster: lessons learned from laparoscopic release of the median arcuate ligament. Surg Endosc 2009; 23:1121-4. [DOI: 10.1007/s00464-008-0256-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2008] [Revised: 08/19/2008] [Accepted: 11/17/2008] [Indexed: 01/04/2023]
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17
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Affiliation(s)
- Audra A Duncan
- Division of Vascular Surgery, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN 55902, USA.
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18
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Sianesi M, Soliani P, Arcuri MF, Bezer L, Iapichino G, Del Rio P. Dunbar's syndrome and superior mesenteric artery's syndrome: a rare association. Dig Dis Sci 2007; 52:302-5. [PMID: 17160476 DOI: 10.1007/s10620-006-9438-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2006] [Accepted: 05/12/2006] [Indexed: 12/09/2022]
Abstract
Celiac artery compression syndrome (CACS) and superior mesenteric artery syndrome (SMAS) are 2 rare diseases, widely described in literature. Their association has not been specifically investigated; in fact, few cases have been reported. For this reason we reviewed our experience from January 1974 to June 2004. We report 59 patients affected by CACS and 28 by SMAS. Coexistence of both syndromes in 8 patients was observed. These 8 patients were successfully treated with duodenojejunal bypass and decompression of the celiac trunk. In this paper, we analyze the pathogenesis, clinical presentation, diagnosis, and treatment of these syndromes, emphasizing their common aspects. The misdiagnosis of this association may justify in some cases the controversial results reported regarding the surgical treatment of these syndrome.
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Affiliation(s)
- Mario Sianesi
- Istituto di Clinica Chirurgica Generale e dei Trapianti d'Organo Università di Parma, Via Gramsci 14, 43100, Parma, Italy
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19
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Linuma Y, Yamazaki Y, Hirose Y, Kinoshita H, Kumagai K, Tanaka T, Miyajima M, Katayanagi N, Kuwabara S, Nakazawa S. A Case of Isolated Celiac Axis Injury by Blunt Abdominal Trauma. ACTA ACUST UNITED AC 2006; 61:451-3. [PMID: 16917466 DOI: 10.1097/01.ta.0000229960.31334.ca] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Yasushi Linuma
- Emergency and Critical Care Medical Center, Niigata City General Hospital, Niigata, Japan.
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20
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Pennington N, Soames RW. The anterior visceral branches of the abdominal aorta and their relationship to the renal arteries. Surg Radiol Anat 2005; 27:395-403. [PMID: 16177834 DOI: 10.1007/s00276-005-0026-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2004] [Accepted: 06/08/2005] [Indexed: 10/25/2022]
Abstract
Variations in the anatomy of the abdominal aorta and its branches are of interest as vessel geometry not only determines flow dynamics, but is also crucial in the pathogenesis of vascular disease. The relationship between the anterior visceral and renal arteries is important when undertaking diagnostic arteriography and endovascular interventions. To examine these relationships, the length of the abdominal aorta was determined and measurements taken of the position of origin of the celiac artery, superior mesenteric artery (SMA), inferior mesenteric artery (IMA) and renal arteries, as well as the three-dimensional projection of each vessel from the aorta. The mean level of bifurcation of the aorta was at the lower third of the body of L4, with the celiac artery, SMA, renal arteries and IMA arising at the level of the T12/L1 intervertebral disc, upper third of the body of L1, lower third of the body of L1 and lower third of the body of L3, respectively. The horizontal projection of the celiac artery, SMA and IMA was to the left of the midline; in the sagittal plane, the celiac artery and SMA projected anteriorly and the IMA posteriorly; in the coronal plane all vessels projected inferiorly, with the SMA to the right and the IMA to the left. The celiac artery, SMA and both renal arteries all arise from the proximal half of the abdominal aorta within 45 mm of each other, with the origins of the renal arteries being remarkably consistent. It is concluded that the celiac artery and SMA are both useful landmarks for determining the position of the renal arteries.
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Affiliation(s)
- Neil Pennington
- School of Biomedical Sciences, University of Leeds, Leeds, LS2 9JT, UK
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21
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Desmond CP, Roberts SK. Exercise-related abdominal pain as a manifestation of the median arcuate ligament syndrome. Scand J Gastroenterol 2004; 39:1310-3. [PMID: 15743013 DOI: 10.1080/00365520410008150] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Abdominal pain related to exercise, often loosely referred to as 'stitch', is not uncommon, particularly among participants in sports that involve running. The cause of this typically transient pain is poorly understood with several aetiologies proposed including diaphragmatic ischaemia (1, 2). Other gastrointestinal symptoms that are common during prolonged or high-intensity exercise include nausea, diarrhoea and gastrointestinal bleeding (3, 4). These symptoms are also usually transient and are thought to protect against critical organ damage by promoting cessation of exercise. Decreased gastrointestinal blood flow, increased motility and altered neuroendocrine modulation are postulated disease mechanisms (3). We report here a case of an elite runner with exercise-related severe abdominal pain and diarrhoea related to compression of the coeliac axis by the median arcuate ligament. Complete symptom relief was achieved with surgical division of the constricting ligament. The clinical characteristics and pathogenesis of coeliac axis compression syndrome are discussed.
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Affiliation(s)
- C P Desmond
- Dept of Gastroenterology, The Alfred Hospital, Melbourne, Victoria, Australia
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Costa MMB, Pires-Neto MA. Anatomical investigation of the esophageal and aortic hiatuses: physiologic, clinical and surgical considerations. Anat Sci Int 2004; 79:21-31. [PMID: 15088789 DOI: 10.1111/j.1447-073x.2004.00060.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Precise knowledge about the anatomical constitution of the diaphragmatic pillars is essential to understand the physiologic, clinical and surgical roles of the esophageal and aortic hiatuses. Because anatomical descriptions found in the literature are dubious, we have decided to investigate this subject. Anatomical dissections and histologic sections of the right and left diaphragmatic pillars (diaphragma crura) from 43 human bodies were analyzed, comprising both non-fixed and fixed specimens. We have described a classification of the diaphragmatic pillars and their muscular branches, forming two basic arrangements (patterns I and II) around the esophageal and aortic hiatuses. Such anatomical and functional relationships between the esophagus and its diaphragmatic hiatus help explain why, during normal inspiration, a hiatal enlargement is observed first but is followed, thereafter, during deep inspiration, by a hiatal narrowing exerted by the contraction of the diaphragmatic pillars. Our results also show that the aortic hiatus does not seem to constitute a rigid ventral tendinous arc around the aorta that could impose any considerable degree of vascular compression, as suggested by other investigators. The present study provides anatomical data useful for a better understanding of gastroesophageal reflux physiology, antireflux surgery and abdominal angina.
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Affiliation(s)
- Milton Melciades Barbosa Costa
- Departamento de Anatomia of the Instituto de Ciências Biomédicas, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
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Faries PL, Narula A, Veith FJ, Pomposelli FB, Marsan BU, LoGerfo FW. The use of gastric tonometry in the assessment of celiac artery compression syndrome. Ann Vasc Surg 2000; 14:20-3. [PMID: 10629259 DOI: 10.1007/s100169910004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This report describes the use of gastric tonometry to measure gastric mucosal ischemia/intestinal mucosa pH (pHi) in a patient treated for celiac artery compression syndrome. Significant gastric mucosal ischemia was demonstrated prior to celiac artery decompression as indicated by a pHi of 7.29. The ischemia was relieved by celiac artery decompression, with an increase in the pHi to 7.48. The patient experienced complete relief of his symptoms after surgical decompression and remains asymptomatic 14 months after surgery. Gastric tonometry provides an objective measurement of intestinal perfusion and ischemia in the treatment of celiac artery compression syndrome.
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Affiliation(s)
- P L Faries
- Division of Vascular Surgery, Department of Surgery, Beth Israel-Deaconess Medical Center/Harvard Medical School, Boston, MA 02215, USA
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Bakal CW, Sprayregen S, Wolf EL. Radiology in intestinal ischemia. Angiographic diagnosis and management. Surg Clin North Am 1992; 72:125-41. [PMID: 1731380 DOI: 10.1016/s0039-6109(16)45631-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Angiography is an essential component of the diagnosis and treatment of patients with acute and chronic intestinal ischemia. Aortography and selective angiography permit identification of the cause and precise anatomy of intestinal ischemic syndromes, and also help plan their potential correction. Direct intra-arterial infusion of pharmacologic agents into splanchnic vessels has now become part of the therapy of these conditions. This article reviews angiographic techniques and their applications in the management of intestinal ischemic syndromes.
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Affiliation(s)
- C W Bakal
- Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
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Would you recognize celiac axis syndrome? Postgrad Med 1991; 89:239-40, 245, 248. [PMID: 1985315 DOI: 10.1080/00325481.1991.11700801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Since its original description, celiac axis syndrome has been a topic of debate. Clinical findings include postprandial abdominal pain, weight loss, and an epigastric bruit. Diagnosis is often made by exclusion and is confirmed by lateral aortography. The role of surgery in treating celiac axis syndrome is controversial.
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Geelkerken RH, van Bockel JH, de Roos WK, Hermans J. Coeliac artery compression syndrome: the effect of decompression. Br J Surg 1990; 77:807-9. [PMID: 2383757 DOI: 10.1002/bjs.1800770728] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The effects of operation to decompress the coeliac artery were evaluated in 11 consecutive patients with coeliac artery compression syndrome. Immediately after the operation all patients were free of symptoms. Three months later three of the 11 had recurrent abdominal pain. Long-term follow-up between 15 and 23 years, obtained by questionnaire, was available for eight patients. All eight had return of symptoms similar to those before surgery. These unsatisfactory results suggest that operation should not be undertaken in patients with vague upper abdominal complaints and compression of the coeliac artery by the median arcuate ligament, who do not otherwise have pathological conditions which might explain their symptoms.
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Affiliation(s)
- R H Geelkerken
- Department of Surgery, University Hospital, Leiden, The Netherlands
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